Neurofeedback and ADD

Kim Trask

What
is ADD?

ADD
is an acronym for Attention Deficit Disorder (this can also be known as ADHD
[Attention Deficit Hyperactivity Disorder]).“Attention-deficit/hyperactivity disorder is characterized by an
age-inappropriate level of inattention, with or without impulsivity and
overactivity, that occurs across settings, causes functional impairment and
cannot be attributed to another disorder” (Mercugliano 831).This is one of the most common psychiatric disorders amongst children
today.According to Linder, Habib,
and Radojevic (1996), ADD affects between 5% and 15% of children.

DSM-IV
CRITERIA FOR ADHD

A.
Either 1 or 2 (or both):

1.
Six or more of the following symptoms of inattention have persisted for at
least 6 months to a degree that is maladaptive and inconsistent with
developmental level:

Inattention

a.
often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities

b.
often has difficulty sustaining attention in tasks or play activities

c.
often does not seem to listen when spoken to directly

d.
often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior or
failure to understand instructions)

e.
often has difficulty organizing tasks and activities

f.
often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework)

2.
Six or more of the following symptoms of hyperactivity-impulsivity have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:

Hyperactivity

a.
often fidgets with hands or feet or squirms in seat

b.
often leaves seat in classroom or in other situations in which remaining
seated is expected

c.
often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective feelings
of restlessness)

d.
often has difficulty playing or engaging in leisure activities quietly

e.
is often on the go or gotten acts as if driven by a motor

f.
often talks excessively

Impulsivity

g.
often blurts out answers before the question has been completed

h.
often has difficulty awaiting turn

i.
often interrupts or intrudes on others (e.g., butts into conversations or
games)

Additional
Criteria:

B.
Some hyperactive-impulsive or inattentive symptoms that caused impairment were
present before age 7.

C.
Some impairment from symptoms is present in two or more settings (e.g., school
or work and at home).

D.
There must be clear evidence of clinically significant impairment in social,
academic, or occupational functioning.

E.
The symptoms do not occur exclusively during the course of pervasive
developmental disorder, schizophrenia, or other psychotic disorder and are not
better accounted for by another mental disorder (e.g., mood disorder, anxiety
disorder, dissociative disorder, or personality disorder) (Mercugliano 833).

It is believed that there are genetic and physiological factors that
can lead to ADD.This is
supported by the fact that “70% of children do not outgrow the attention and
learning problems associated with ADD… Incidence rates are much greater
among family members” (Linden, Habib, & Radojevic, 1996, 36).

What
are treatments for ADD?

There
are many different treatments for ADD.Stimulants
are a common way of suppressing ADD.Drugs
such as Ritalin, Dexedrine, and Aderall are often prescribed for people
diagnosed with ADD.There has
been a large increase (248%) in the amount of stimulants being prescribed in
the ten-year period between 1971 and 1981 (Tan & Schneider, 1997).One of the drawbacks using stimulants to treat ADD is that they can
become addictive.Young children
cannot become dependent on their prescriptions (http://www.add.org/content/treatment/meds1.htm).These drugs are often effective in most people.

However,
there are some cases in which stimulants do not work.In these cases tricyclic antidepressants or antihistamines may be used
to treat ADD.Clonidine is an
example of a treatment that had been prescribed when stimulants have failed to
produce the expected results (http://www.add.org/content/treatment/meds1.htm).Other medications are: Norpramin, Tofranil, Catapres, Tenex,
Prozac, and Wellbutrin (Tan & Schneider, 1997).

The
preceding treatments have some side effects that should be anticipated.These can be any of the following:

These
can be anticipated and avoided by altering the dosage of the medication.These side effects often disappear after the first six months of
treatment (Tan & Schneider, 1997).

There is an
alternative (“non-medication”) way of treating ADD: Neurofeedback.

What
is neurofeedback?

Neurofeedback
is “designed to help [people] correct problems in brain function such as ADD”
(http://www.eegspectrum.com/school/anders98.htm).This process is supposed to teach ADD patients how to control their
brain waves.This procedure
yields permanent results.As
opposed to the medications, which can only temporarily relieve the person from
the characteristic symptoms of ADD.The
problems are only suppressed until the medication wears off.However, once a person is taught to control their brain waves, they
have control over them indefinitely.

What actually happens during
neurofeedback?

“Sensors
are attached to the scalp and ear using conductive paste.These sensors measure frequencies and amplitudes produced by the brain.The computer then converts this information into visual and auditory
feedback.This way the person can
begin to experience how their brain is reacting during different situations,
and learn how to change their brain wave patterns.By continuously practicing, the individual learns to change and control
their brain patterns” (http://webideas.com/biofeedback/research/minevich.htm).

During
this process, patients are believed to increase the amplitude of their beta
waves (12-20 Hz).These types of
brain waves are associated with concentration and attention.Patients also decrease the amplitude of their theta waves (4-8 Hz)
during the neurofeedback process.These
are linked to inattentive behaviors.Various
researchers have defined the waves differently, so the previous values
encompass all of them (http://webideas.com/biofeedback/research/minevich.htm).

In
the study done by Linder, Habib, and Radojevic (1996), the following method
was used.“The EEG biofeedback sessions were 45 minutes in length and
consisted of electrode attachment and 3 10-minute EEG biofeedback segments:
(1) standard training (biofeedback with eyes open while attending to visual
and auditory feedback), (2) a reading task (biofeedback during reading age
appropriate books), and (3) an auditory listening task (biofeedback while an
assistant read age appropriate material to them).During the reading and listening sessions, if the subject
stopped receiving feedback rewards (points or tones) the task was temporarily
stopped and the subject was instructed to concentrate until the rewards began,
and then continue reading or listening…At the conclusion of each training
day, the subjects were given small rewards (e.g., baseball cards, stickers),
which were provided based on their levels of cooperation, effort, and
performance” (40).

Who
can benefit from it?

According to Joel F.
Lubar, Ph. D., one of the primary researchers of neurofeedback, almost all
people diagnosed with ADD or ADHD can benefit from neurofeedback.There are however some restrictions.The patient must be between the ages or 7 and 45.The candidate for therapy can be of any intelligence.The person cannot be experiencing any of the following:

Neurofeedback
is supposed to allow a person to control their beta and theta activity.This will allow for them to focus on learning; therefore, school grades
will improve.This will also
bring about higher scores on standardized tests (to measure intelligence).There should also be a dramatic improvement in behavior.This will facilitate the betterment of relationships with peers.Job performance will reach the standard, if not surpass it.The patient will being to realize that he/she has a greater potential
than previously believed and will begin to strive to reach it.The scores of Parent-Teacher ratings will begin to improve after the
therapy.Combined these will
improve the patient’s self-esteem (http://www.selfgrowth.com/articles/lubar.html).

How
well does it work?

There
have been numerous studies on the effectiveness of neurofeedback in the
treatment of ADD.In 1995, Lubar,
Swartwood, Swartwood, and O’Donnell did a study involving 23 subjects who
ranged from ages eight to nineteen.The
study was conducted over a two to three month period in the summer.The goal was to have each patient go through forty sessions of
neurofeedback (each session was one hour of training).The study was divided into three parts.Part one had 19 participants; it’s objective was to determine the
effect of neurofeedback on a continuous performance task (T.O.V.A.).There were significant changes in the T.O.V.A. performance after the
neurotherapy.“The effects of
neurofeedback appear to provide a change in performance without continual
external intervention” (Lubar, Swartwood, Swartwood, & O’Donnell,
1995, 91).In comparison to
pharmacological treatments, which only last as long as the drug is in the
patient’s system.

Part
two had 13 participants; it’s objective was to determine the effect of
neurofeedback on behavior ratings.The
behavior was assessed by parents using the McCarney Attention Deficit Disorder
Evaluation Scale (ADDES).ADDES
measures the patient’s inattention, impulsivity, and hyperactivity.The results from this part showed an improvement whether or not the
patient showed EEG changes.However,
“parents often tend to overemphasize positive gains that are [a result of
treatment]” (Lubar, Swartwood, Swartwood, & O’Donnell, 1995, 93).For this type of assessment, a parent would not be the one to do the
evaluation, strictly for reasons like this.

Part three had 10 participants; it’s objective was to determine
effects of neurofeedback on IQ scores.All
subjects made significant improvements on the IQ scores.This data is valid because of the time span (more than six months)
between the test and retest (Lubar, Swartwood, Swartwood, & O’Donnell,
1995).

Linden, Habib, and Radojevic conducted another study in 1996.This study consisted of 18 children aged five through
fifteen.They were split into an
experimental and waiting list control group.The experimental group was given forty 45-minute sessions of
neurofeedback training.The goal
was to increase beta activity and decrease theta activity.

The results from this study led the researchers to believe that the
participants’ beta activity increased and theta activity decreased.There was an average increase in IQ of nine points in the
experimental group.Inattentive
behaviors decreased as a result of the neurofeedback training.As in Lubar, Swartwood, Swartwood, and O’Donnell (1995), there was
not a significant difference in the two groups aggressive/defiant behaviors.

On of the problems with this study was that the EEG data from each
subject could not be compared to each other’s data.There were software restrictions and revisions; therefore, the
threshold settings were inconsistent.Another
problem was that the subjects were rewarded for their improvement (Linden,
Habib, & Radojevic, 1996).So
the subjects’ behavior may be a result of being rewarded, not a result of
the neurofeedback training sessions.

None of the studies involving the effect of neurofeedback on ADD have
been large enough or controlled enough to say that this is a very effective
way of treating ADD.However, in
all the studies, the patients’, who underwent neurofeedback therapy,
conditions were improved.But
there needs to be more research in which the controls are better and the
groups are large enough to draw valid conclusions.

Linden,
Michael; Habib, Thomas; & Radojevic, Vesna.(1996).A Controlled Study
of the Effects of EEG Biofeedback on the Cognition and Behavior of Children
with Attention Deficit Disorder and Learning Disabilities.Biofeedback and Self-Regulation, 21:1. 35-48.

Lubar,
Joel F.(1991).Discourse on the Development of EEG Diagnostics and Biofeedback for
Attention-Deficit/Hyperactivity Disorders.Biofeedback and Self-Regulation, 16:3, 201-223.